Looming adult Medi-Cal cuts leave local and state healthcare safety net anxious

Along with her three children and husband, Santa Cruz County resident Maria Montesinos receives health care through Medi-Cal. She is afraid that keeping herself and her family healthy will soon become too difficult.

Wheelchair-bound and beset by a litany of health issues, Ricardo Madrigal Moreno is grateful for the first-rate dental care adult Medi-Cal affords him. But the 63-year-old, who lives in Watsonville, risks losing his dental coverage next month. see full story...

Yaritma Alvarado also lives in Santa Cruz County. She supports herself and her two young sons, relying on the state-funded Healthy Families program for health care. Come July 1, Healthy Families may be eliminated, and taking her children to the doctor may become a costly luxury out of her reach.

“I might have to take my children to the doctor only when they absolutely need it,” Alvarado says. “Even then, I’m going to have to think twice about it.”

Montesinos, Moreno, and Alvarado embody the human cost of the California State Legislature’s decision to cut adult Medi-Cal’s ‘optional’ benefits, among others – called so not because they are not vital, but because the state is not required to fund them. Barring any fiscal or legal cures, the optional benefits will be cut effective July 1. The 2009-2010 state budget does not include room for them.

The benefits are not deemed essential by the state, but the programs they cover –Medi-Cal adult dental, optometry, and adult day care— play a vital role in keeping the most vulnerable members of the local community healthy. The promise of their termination has left these recipients, and the health providers that care for them, bruised by the state, uneasy and reeling to run contingency plans and find solutions by the looming deadline.

“The long-term consequences of not having primary dental care, both preventive and treatment, which people can access through Medi-Cal, is going to cause deteriorating oral health, which then will cause other systemic health problems,” says Sara Clarenbach, director of advocacy, community engagement and media relations for Salud Para la Gente (SPLG), a local organization that provides a safety healthcare network for local low-income communities.

Elderday, a Santa Cruz adult day health care center run by Salud, provides daytime supervised therapy and activities for elders who cannot be cared for at home. Should the legislature’s cuts follow through, the federally qualified health center will not be able to operate.

“There are 133 elders who are enrolled in Salud’s Elderday program,” says Clarenbach. “If the program closes they are going to go to skilled nursing facilities, hospitals, and emergency rooms in very significant numbers because these people are too frail and have too many complicated medical conditions to stay home, and home care is often not feasible.

“The short of it now is that the people who go to Elderday during the day will be institutionalized at a much greater cost to their families and to society. For the Elderday participants the level of suffering will be just unbelievable, and their families will suffer as well.”

According to a recent University of California, San Francisco report, “Eliminating Medi-Cal Dental: Costs and Consequences,” the costs to patient health and the threats to healthcare safety nets outweigh the potential fiscal savings from proposed budget cuts. California stands to save $109.3 million from the cuts, but it will lose at least $134.5 million in federally matching funds, and an untold amount from loss of jobs and from dental disease and its effects on a person’s ability to work.

Some health providers and their patients continue to demand that services not be cut. In April, the California Primary Care Association filed a lawsuit seeking a writ of mandate preventing the state from eliminating reimbursement for Medi-Cal adult dental, chiropractic, optometry, podiatry, and psychology services when provided by federally qualified health centers. On June 3, representatives from adult day health centers gave public testimony to the legislature’s Joint Conference Committee in opposition to the proposal to cut Medi-Cal funding for adult day health care.

Both decisions are pending; for now, many health providers can only play a tense waiting game.

“You hear this phrase quite often now, that we’re ‘tearing the social fabric’ or breaking the social contract,” Clarenbach says. “Unless the Governor and legislature change course, and/or the Sacramento Superior Court blocks elimination of Medi-Cal optional benefits, no one in the safety net or community health care system is going to come out of this unscathed. Everybody is going to take a hit. The question is: how bad is it going to be?”